Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 35-040257 | OH |
Y | 208600000X | Surgeon | 35-040257 | OH |
NPI | 1023038742 |
---|---|
Provider Name | Thomas A Stellato |
First Address | South Euclid, OH 44121 |
Second Address | South Euclid, OH 44121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 13/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000621883 | ANTHEM (01) | OH |
0421994 | (05) | OH |
364045 | WELLCARE (01) | OH |
A84013 | (02) |